If you are treating hepatitis B and are unable to normalize ALT levels, be sure of three things: (1) are they taking the Rx everyday? (2) has drug resistance developed? and (3) do they have a hepatitis delta superinfection? Advertisements
Secondary sclerosing cholangitis is a mimic of primary sclerosing cholangitis (PSC) in its biochemical profile, radiographic appearance and clinical behavior. Instead of being primarily immune mediated, it occurs as a secondary reaction to an insult like infection, ischemia, surgical complications or a … Continue reading
“I dare you to read the first twenty pages and not keep going.” – Chicago Tribune “Is there another living writer with as firm a grasp on the subject? One word- No!” – USA Today “A Tour de Force.” – … Continue reading
Leukonychia, or “white nail” is sometimes found in liver disease. In particular, it may be an indication of hypoalbuminemia. With a high pre-test probability of late-stage disease (ie. thrombocytopenia, hyponatremia) synthetic dysfunction may be reflected in the nail exam. Remember … Continue reading
(NEJM, May 2010) In this study, 80 patients received pioglitazone 30 mg/day, vitamin E 800 IU/day or placebo for two years. Nobody had diabetes mellitus, though insulin resistance was present. Biopsies were performed before and after. Major side effect included … Continue reading
If you suspect a patient is abusing alcohol, think outside the box and order GGT (if alkaline phosphatase is normal) and IgA levels. Each of these may be elevated during alcohol abuse.
Recognize that when a common bile duct is obstructed by a gallstone, the intrahepatic bile ducts may not dilate if the liver is cirrhotic, due to its firm, non-expansile nature.